toxiology

7/29/2019 toxiology

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Rishikul State P.G. Ayurvedic college &Hosiptal

Haridwar (Uttarakhand)

DEPARTMENT OF TOXICOLOGY

AND

MEDICAL JURISPRUDENCE

Topic: - Carbolic acid, Strimulunts,

Hallucinogcns – LSD

Sedatives and Hypnotics – Barbiturutes

Submitted to-: Submitted ByDr. Ravi Srivasthav Kavita Rana

Dr. Ramesh Tewari B.A.M.S (2nd )prof

Dr. Manoj Adlakha Batch - 2010

Dr. Aswni Kumar

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PhenolC6H5OH

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• Carbolic acid is

hydroxybenzene obtainedfrom coal tar oil by synthesis.It consists of colorless,prismatic needle like crystalswhich on standing becomes

pinkish with a peculiar phenolic odour. Even though itdoes not turn blue litmus redand has no acid reaction, it iscalled an acid because it

forms carbolates (Salts) whenacted upon by strong bases.

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• Fatal dose : 20 drops or 30 grains.

• Fatal period : Average : 3-4hours

Minimum 3

minutes

Maximum 60hours

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• Carbolic acid poisoning is known

as carbolism.It has following two actions –

(a) Local Action (on skin and

alimentary tract)

(b) Remote Action (after absorption)

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1. Carbolic acid produces

burning sensation, tinglingand numbness when appliedover the skin.

2. When swallowed it produceshot burning pain extendingfrom mouth to the stomach,

followed by tingling sensationand anaesthesia. Swallowingand speech are painful anddifficult. The lips, mouth andtongue are corroded.Occasional vomiting of frothy

mucus with a strong smell of carbolic acid may be present.

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1. Cold, clammy and pale skin.

2. Weak and thready pulse.

3. Contracted and pinpoint pupils.

4. Strong smell of carbolic acid from breath.5. Supression of urine or oliguria.

6. Carboluria- When exposed to air, the metabolic

products of carbolic acid(i.e. hydroquinone and

pyrocatechol) are oxidised resulting in dark smokygreen colour of the urine. This symptom is known as

carboluria which serves as the warning of the toxic

properties of the carbolic acid.

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Death result from paralysis

of respiratory or cardiac centre.

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Treatment

1. Gastric lavage with lukewarm water containing animal charcoal,olive oil, magnesium or sodium sulphate or 10% glycerine in water till the returning fluid loses phenolic odour.

2. Liquid paraffin, olive oil, vegetable oil may be left in the stomachafter washing.

3. Demulcents like white of egg or milk may be given.

4. Intravenous saline with sodium bicarbonate should beadministered to render the urine alkaline.

5. Oxygen inhalation and artificial respiration, if needed.

6. Castor oil or olive oil is applied preferably in the form of spray to theburns (caused by carbolic acid after washing with 10% ethylalcohol, soap solution and water.

7. Rest of the treatment is symptomatic.

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• It is a popular suicidal agent due

to its easy availability as it iscommonly used as antiseptic,

disinfectant and surface

anaesthetic etc.

• It is rarely used for homicide due

to its detectable odour and

taste.

• It may be used to procure

abortion.

• Accidental poisoning may occur

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• Dark brown excoriations may be seen onthe angles of the mouth and chin.

• Ash grey patches of corrosion are seen on

the lips and mouth.• The mucous membrane of the stomach and

duodenum are brown, leathery with submucosal haemorrhagic spots and prominentrugae. Smell of carbolic acid is perceptibleon opening the stomach.

• Kidneys are enlarged, highly congested andshow signs of acute haemorrhagic nephritis.

• Lungs are congested and oedematous.

• Brain is congested.

• The blood is dark, semifluid and partially

coagulated.

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• Introduction Antihistamines drugs are used in allergic

disorders, cold & parkinsons disease etc. Theyantagonise the action of histamine.

They also have anticholinergic, antiadrenaline andanti-serotonin effects.

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• Death in antihistaminic poisoning occurs from respiratory

failure.

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Initial depression followed by excitation of the central nervoussystem.

Dryness of mouth

Nausea

Vomiting

Headache Blurred vision

Urinary retention

Fixed dilated pupils

Disorientation

Ataxia

Hallucinations

Stupor

Coma

• Fatal Dose : 1 Gram

• Fatal period : 3 to 18 hours

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• Stomach wash with warm water and sodium bicarbonate.

• Diazwpam for convulsions 0.2-0.5 mg/kg body weight I.V

slowly followed by repeated doses as required.

(maximum dose of 100 mg/day)

• Oxygen inhalation and artificial respiration, if required.

• Rest of the treatment is symptomatic.

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1. Postmortem Appearances

same as of asphyxia.

2. Medicolegal aspects

Poisoning is mostly accidental from

overdosage.

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• Introduction

Cocaine is an alkaloid

deliriant derived from the dried

leaves of the plant Erythroxylum

coca. It is odourless, colourless,

crystalline substance with bitter taste and slightly soluble in water

but freely soluble in alcohol. It is

often available with pan sellers.

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• Smoking

• Chewing

• Snorting (application to nasal mucous

membrane)

• Intravenous Injectio

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• (a) INTERNAL : It first acts as a stimulant and then

depresses the central nervous system.

• LOCAL : It blanches mucous membranes, dilates the

pupil and paralyses the sensory nerve terminals.

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• Local Tingling sensation and feeling of numbnessat the site of application.

• Face Flushed

• Skin Pallor

• GIT Dysphagia

Nausea

VomitingBitter taste

Dryness of mouth & throat

CNS Sense of happiness & well being

excitement

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Restlessness

Talkativeness

Hallucinations

Tremors

Convulsions

Coma

CVS TachycardiaMyocardial ischaemia

RS Dyspnoea

Cyanosis

Ocular Pupils dilatedTemperature Sudden rise with a rigor

General Increased libido (sexual desire)

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• After an hour, stage of excitement is followed by stage of

depression which in characterised by profuse sweating, feeble

respiration and collapse, ending in death from respiratory or

cardiac failure.

Fatal dose : 1 gm orally

Fatal period : About 2 hours

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• If swallowed, stomach wash should be done with potassium

permanganate or tannic acid solution.• If injected, torniquet should be applied above the part of

injection to delay its absorption.

• If applied locally to nose etc., it should be washed out withnormal saline or lukewarm water.

• Excitement should be controlled by diazepam.

• Oxygen inhalation and artificial respiration, if required.

• Amyl Nitrite, an antidote is given by inhalation.

• Rest of the treatment in symptomatic.

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• Brain, spinal cord & other internal organs are congested.

• General asphyxial signs (Cyanosis, frothing at the mouth

and nostrils etc.)

• Pupils are found dilated.

• Cardiac dilatation.

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1. Cocaine is common drug of addiction in young

individuals.

2. Its is rarely used for homicide or suicide.

3. Accidental cases may occur from urethral, vesical and

rectal injection.

4. It is believed to increase the duration of sexual act by

depressing the sensory nerves of glans penis.

5. It is rapidly detoxified by the liver and thus it is difficult to

detect it in the viscera.

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• Hallucinogens are the drugs which produce abnormal

effects on the mind such as distortion of time. Space,

sound, colour and other sensations. They are also known

as psychedelics.

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Introduction

LSD is the most ptentand widely usedhallucinogenic drug havingmarellous effect even inminute doses. It is

synthesized from rye ergot. Itis generally taken byyoungsters in a spirit of adventure to enter a world of fantasy or to escape from the

realities of life.

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• It acts mainly on the central nervous system and

interferes with the filtering mechanisms of the mind

resulting in altered perception, thinking and mood.

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• Emotional swings

• Hallucinations

• Suspiciousness

• Bizarre behavior

• Synaesthesia

• Nausea and vomiting

•

Widely dilated pupils• Insomnia

• Tremors

• Vertigo

• Headache

Psychotic reactions

Sudden recurrences (flashbacks ) of the adverse effect

especially bad trips.

Permanent damage to brain

cells.Fatal dose : Uncertain

Fatal period : not known

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• Limit stimulation

• Tranquilizers or barbiturates

• Psychotherapy

•

Symptomatic measures

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1. It is habit forming and produces psychological

dependency.

2. Panic attacks, depression and paranoid reactions have

been seen.

3. Suicide, homicide and accidental deaths by

misadventure are common.

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• Sedatives are drugs that sudue excitement and

produce a calming effect on the central nervoussystem while hypnotics are the drugs which induce

and maintain sleep.

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Introduction:Barbiturates are commonly

used as sedatives, hypnotics,

anaesthetics, anticonvulsants

and tranquilizer etc. They occur as

white, crystalline, odourless powder

and are bitter in taste.

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• Barbiturates are classified into following four groups depending upon their duration of action:-

• 1. Long Action (Duration 8 to 16 hours)

• Phenobarbitone (Luminal)

• Sodium barbitone (veronal)

• Diallybarbituric acid (Dial)

• Sodium pento barbitone (Soluble Luminal)

• 2. Intermediate (Duration 4 to 6 hours)

• Butobarbitone (Soneryl)

• Soium pentobarbitone (Nembutal)

• Amylobarbitone (Amytal)

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• 3. Short acting (Duration 3 to 6 hours0

•

Hexabarbitone• Sodium quinal barbitone (Soneryl)

• Secobarbital (Seconal)

• Cyclobarbitone (Phanodorm)

• 4. Ultra short acting (for duration of anaesthesia)

• Brevital (Methohexobarbitone)

• Pentothal (Thiopentone sodium)

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• Barbiturates are hypnotic and depress the central nervous system.

The effect of barbiturates varies from mere tranquillity to coma

depending upon the dose. Death may be due to respiratory failure

or ventricular fibrillation in early stages and bronchopneumonia or

pulmonary oedema in later stages.

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• Central Nervous - Headache

System - confusion- Disorientation

- Excitement

- Delirum

- Hallucinations

- Ataxia- Loss of reflexes

- Pupils constricted but reacting to light.

- Stupor progressing to coma

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• Cardio-vascular - Hypotension

System - Bradycardia- Cyanosis

- Low Cardiac output

.Renal - Scanty and dark uirne

- Urine incontinence

. Others - Blisters are found on theskin

- Hypothermia

- Loss of muscle tone

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1. Stomach wash with warm water using potassiumpermanganate and animal charcoal.

2. Solution of magnesium sulphate should be left in thestomach for purgation and to minimise intestinal absorption.

3. Body warmth should be maintained.

4. Mechanical ventilation with O2 (artificial respiration)should begiven.

5. 2.5 mg of metaraminol (Aramine ) I.V. to combat shock.

6. Diuresis : I.V. Sodium bicabonate. (2-3 ampoules) in one litre

of 5% dextrose at the rate of 30 ml/kg/hr.7. Dialysis and exchange transfusion, if needed.

8. Antibiotics and symptomatic treatment

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1. External - Asphyxial findings

- Cyanosis

- Barbiturate blisters

- Froth in mouth & nostrils- Congested face

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• Mucosa of alimentary canal is congested.

• Kidneys show degenerative changes in convoluted

tubules.

• Lungs are congested and oedematous.

• Subendocardial hemorrhages may be seen in heart.

• White particles may be seen in stomach with eroded

gastric mucosa.

•

Other organs are also found congested.

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• Mostly deaths from barbiturates are either suicidal or

accidental.

• Homicidal death from barbiturates is rare.

• Addiction may occur due to excessive use of

barbiturates.

toxiology

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